Provider Demographics
NPI:1275853269
Name:HAQ, AMAAN ABDUL (MD)
Entity Type:Individual
Prefix:
First Name:AMAAN
Middle Name:ABDUL
Last Name:HAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 JOHN R ST
Mailing Address - Street 2:SUITE 708
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2020
Mailing Address - Country:US
Mailing Address - Phone:313-745-6817
Mailing Address - Fax:313-745-6828
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:SUITE 708
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-745-6610
Practice Address - Fax:313-745-6828
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301096545207Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine